Author/Authors :
Öztürk, Semi Department of Cardiology - Haseki Training and Research Hospital - İstanbul - Turkey , Durmuş, Gündüz Department of Cardiology - Haseki Training and Research Hospital - İstanbul - Turkey , Kalyoncuoğlu, Muhsin Department of Cardiology - Haseki Training and Research Hospital - İstanbul - Turkey , Sarı, Mustafa Department of Cardiology - Haseki Training and Research Hospital - İstanbul - Turkey , Can, Mehmet Department of Cardiology - Haseki Training and Research Hospital - İstanbul - Turkey
Abstract :
A 71-year-old woman presented with shortness of breath
and involuntary head shaking. Physical examination showed
nodding of the head with each heart beat (Video 1). Her pulse
rate and blood pressure were 40 bpm and 125/55 mm Hg, respectively. ECG revealed complete atrioventricular block with
a ventricular rate of 40 and atrial rate of 75 (Fig. 1a). Transthoracic echocardiography displayed moderate aortic regurgitation (AR) and diastolic and systolic mitral regurgitation
(MR) (Video 2). Long ventricular diastole caused an increase
in the severity of AR, which was perceived to be moderate
initially. Increased LVEDP due to relatively acute and severe
AR causes early and severe systolic MR (Fig. 1b). Diastolic
MR occurred when P waves came in early or mid-diastole
but not in systole (Fig. 1c–e). Symptoms relieved after DDDR
pacemaker implantation (Video 3).
